Abstract 719: Impact Of Healthcare Coverage On Ischemic Heart Disease Mortality

Abstract

Introduction: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality in the United States (U.S.). Health insurance influences outcomes associated with cardiovascular disease. Therefore, we explore the impact of the lack of health insurance on IHD mortality rates in the U.S. Hypothesis: Populations with a high prevalence of adults without health insurance have greater IHD mortality rates. Methods: Cross-sectional analyses were conducted to obtain IHD mortality and healthcare coverage data from the CDC Wide-Ranging Online Data for Epidemiologic Research and PLACES databases, respectively. Age-adjusted mortality rates (AAMR) related to IHD (ICD10: I20-I25) were obtained for 2018 and 2019. The age-adjusted prevalence of current lack of health insurance among individuals aged 18 to 64 years were obtained and placed into four quartiles. First quartile (Q1) included the least age-adjusted prevalence of adults without health insurance and fourth quartile (Q4) included the greatest age-adjusted prevalence of adults without health insurance. IHD-related AAMR were compared among quartiles. Results: Overall AAMR was higher in Q4 (92.79 [95% CI, 92.35 - 93.23]) compared to Q1 (83.14 [95% CI, 82.74 - 83.54]), accounting for 9.65 excess deaths per 100,000 person-years. Mortality rates in Q4 for males (126.20 [95% CI, 125.42 - 126.98] and females (65.57 [95% CI, 65.08 - 66.05]) were higher compared to Q1 (115.72 [95% CI, 114.99 - 116.44] and 57.48 [95% CI, 57.04 - 57.91], respectively), accounting for 10.48 and 8.09 excess deaths per 100,000 person-years for males and females, respectively. Similar trends were seen among Hispanic and non-Hispanic populations. Compared to Q1, a higher age-adjusted prevalence of adults without insurance in Q4 accounted for 27.13 and 13.64 excess deaths for Hispanic and non-Hispanic populations, respectively. Lastly, geographic analyses revealed similar trends for Northeastern, Southern, and Western regions, with Q4 accounting for 49.2, 8.15, and 29.04 excess deaths per 100,000 person-years, respectively, compared to Q1. No increase in mortality within Q4 compared to Q1 was observed for Midwestern regions. Conclusion: A lack of healthcare coverage is associated with increased IHD mortality rates.